Breast cancer is a significant cause of mortality and morbidity. It is the most common cancer in women and in Ireland, one in eleven women are at risk of developing breast cancer.
As occupational health professionals, we are frequently asked to advise both the patient and employer on return to work issues.
I recently came across an article about the factors that influence the return to work process in breast cancer survivors. The study interviewed survivors, in various stages of recovery over a 3 month period, and attempted to understand the RTW process after a cancer diagnosis from the perspective of the survivor.
The study utilised the ICF, a framework for describing health disability and the impact on functioning, across the following domains:
- Disease/Disorder;
- Body Function;
- Body Structure;
- Activity/Participation;
- Personal Factors;
- Environmental Factors.
The study found that participants mentioned key barriers in all domains, whereas key facilitators were found in environmental factors only.
In addition the authors concluded that there is accumulating evidence that most employed breast cancer survivors are able to return to work, but often experience difficulties managing their work, for instance due to physical work limitations (eg. arm function), and cognitive work limitations (eg. concentration, fatigue), or as a result of suboptimal treatment at the workplace (discrimination, unsupportive work environment). With this in mind, they conclude that the majority of these barriers to return to work are potentially modifiable.
The return to work process is composed of two stages, an initial stage, and a post-return to work stage. The diverse array of barriers means that individual guidance is essential and intervention should be targeted to specific time periods (initial and post-RTW) as different barriers are experienced at different time points.
So, given this information, what does this mean for us, as occupational health professionals.
Over the entire return to work process, the most important thing is to maintain communication with the absent staff member. The important thing is that the staff member at a time of personal vulnerability understands that they have your support.
Establishing a clear plan for how the employee will return to the workplace helps to ease the stress for the employee which is very important when someone is dealing with a serious illness like breast cancer.
The same study found that a significant omission on behalf of the employer was a lack of follow-up further on in the rehabilitation process. It’s important to note that even if life goes on seemingly as normal for the organisation, the affected staff member has experienced a major life-altering event.
What often matters are the little things; a check-in message on a regular basis during absence and rehabilitation, not broaching the topic of a return until the early stages are completed, and continued support once they have successfully returned.
Once your employee has returned to the workplace, it’s important for them to have flexibility in their working hours for the first few weeks. Advice needs to be personalised-some may require more time at home, others may simply want to return to normal as quickly as possible. A key facilitator, identified by every participant as being one of the most important factors was having a strong support network.
Conclusion.
Overall, the key takeaway is that each situation is different, and you can never be truly prepared for what a cancer diagnosis could bring, but, by having a plan and making sure that you maintain communication, the return to work process can be facilitated and allow most breast cancer survivors return to work successfully.